Diseases of the Stomach and Vomiting

Question 1

What are 4 main differences between vomiting and regurgitation?

Answer 1

Regurgitation has no prodromal signs
Regurgitation is passive
Regurgitation is usually shortly after feeding
Undigested food (often sausage shaped)

Question 2

What are 3 things you should consider from the history of the vomiting patient?

Answer 2

Recent dietary changes?
On any medication?
Recent anesthesia?

Question 3

What are 2 questions you might ask about the quality of the vomit?

Answer 3

Blood or “coffee grains”?

Is it undigested/partially digested food?

Question 4

T/F: Vomiting is a relfex.

Answer 4

True

Question 5

Where is the vomiting center?

Answer 5

In the medulla

Question 6

What do you see in the prodromal phase?

Answer 6

Hypersalivation

Question 7

What are 4 possible ddx for acute gastritis?

Answer 7

Bad/rich food
FB
Toxins
Drugs

Question 8

What are 3 possible ddx for chronic gastritis?

Answer 8

IBD (Lymphoplasmacytic)
Helicobacter
Physaloptera

Question 9

What is a possible ddx for gastric outflow problems?

Answer 9

Idiopathic hypomotility

Question 10

What are 3 possible ddx for infiltrative gastric dz?

Answer 10

IMB
Neoplasia
Pythiosis

Question 11

What are your first 4 steps in approaching a vomiting patient?

Answer 11

Systemic evaluation
Fecal
Imaging
Therapy

Question 12

What are 4 possible therapies for a vomiting patient?

Answer 12

Deworm
Drugs
Bland diet
Fluids (if indicated)

Question 13

What diagnostic approach would you take with acute vomiting and not ill?

Answer 13

Non-specific rx

Question 14

What diagnostic approach would you take with acute vomiting and an ill patient?

Answer 14

Non-specific rx and workup

Question 15

What diagnostic approach would you take with a chronic (over 7 days) vomiting patient.

Answer 15

Non-specific rx
Treatment trials and work up (need to figure out wtf is going on)
Biopsy

Question 16

What 4 things would you do if you have hematemesis?

Answer 16

Determine origin (GI vs Resp.)
Evaluate coagulation
MDB
Imaging

Question 17

What is “chronic” vomiting?

Answer 17

More than 7 days of vomiting

NOTE: Relatively common in dogs and cats

Question 18

What will you likely need to do for a definitive dx in a chronic vomiting case?

Answer 18

Biopsy

Question 19

What 3 things can help you exclude systemic dz in a vomiting case?

Answer 19

Hx
Exam
Routine labs

Question 20

What 3 systemic dz might be excluded if an eosinophilia is detected?

Answer 20

Allergies
IBD
Verminosis

Question 21

If you have a hypochloremia on your biochemestry, what systemic dz can you exclude?

Answer 21

Stricture

Question 22

What is NOT appropriate to do with a chonic vomiting dog?

Answer 22

Withhold food

Question 23

When is a diet trial not appropriate?

Answer 23

In systemically unwell patients

Question 24

Cats with ______ tend to vomit and a large percentage respond to diet moditication.

Answer 24

IBD

Question 25

With a vomiting patient, what 3 general symptomatic therapies would you use?

Answer 25

Anti-emetics Antacids/Gastroprotectants Pro-kinetics

Question 26

When is the use of anti-emetics contraindicated?

Answer 26

If a FB is suspected

Question 27

What are the 3 most common anti-emetics that you would use with a vomiting patient?

Answer 27

Maropitant (central and peripheral) Metoclopramide (central in dogs) Ondansetron (central in cats, peripheral in dogs)

Question 28

What are the 3 most common anti-ulcer meds that you would use with a vomiting patient?

Answer 28

H2 receptor Omeprazole Sucralfate

Question 29

What is important to remember about Cimetidine?

Answer 29

It may interfere with the metabolism of other drugs

Question 30

What 2 things are important to remember about Ranitidine?

Answer 30

It has a pro-kinetic effect | IV use may cause hypotension

Question 31

What 4 things does endoscopy allow us to examine?

Answer 31

Esophagus Sphincter Stomach Proximal duodenum NOTE: Never leave without a biopsy souvenir

Question 32

After what other procedure should you perform endoscopy?

Answer 32

After US

Question 33

What is the underlying cause of chronic gastritis?

Answer 33

Cause is rarely identified

Question 34

How is chronic gastritis classified?

Answer 34

According to cellular infiltrate

Question 35

What is the most common type of chronic gastritis?

Answer 35

Lymphoplasmacytic

Question 36

What 2 things can you do to help manage lymphoplasmacytic chronic gastritis?

Answer 36

Diet modification | Immunosuppressant medication

Question 37

What bacteria is often identified in chronic gastritis?

Answer 37

Helicobacter NOTE: In humans, is associated with gastric neoplasia

Question 38

What are 3 things you'll see on biopsy to help diagnose Helicobacter?

Answer 38

Associated inflammation Intracellular location Epithelium changes

Question 39

What is the test of choice for diagnosing Helicobacter?

Answer 39

Cytobrush via endoscope

Question 40

What are 2 tests that you can do for Helicobacter other than the cytobrush?

Answer 40

``` Biopsy Urease test (CLOtest) ```

Question 41

Why is it not just enough to see Helicobacter to diagnose?

Answer 41

Because it could be normal

Question 42

Why is it not just enough to see Helicobacter to diagnose?

Answer 42

Because it could be normal

Question 43

What is the most common gastric tumor?

Answer 43

Adenocarcinoma

Question 44

What 3 dog breeds most commonly get adenocarcinoma?

Answer 44

Belgian sheperds Collies Staffies

Question 45

What is the clinical sign of adenocarcinoma?

Answer 45

Hematemesis

Question 46

How is adenocarcinoma diagnosed and confirmed?

Answer 46

Diagnosed :US | Confirmed: Biopsy

Question 47

Why do adenocarcinomas often have such a poor prognosis?

Answer 47

Because they are highly infiltrative and complete excision is difficult

Question 48

What is the most common type of GI neoplasia in cats?

Answer 48

GI lymphoma

Question 49

What is the best way to diagnose a GI neoplasia?

Answer 49

Surgical biopsy NOTE: Take multiple

Question 50

What is a high grade lymphoma?

Answer 50

Rapidly dividing, lymphoblasts

Question 51

What is a low grade lymphoma?

Answer 51

Slowly dividing, lymphocytes

Question 52

Which grade lymphoma responds rapidly to chemo?

Answer 52

High grade because of rapidly dividing cells

Question 53

What do you need to confirm the grade of lymphoma?

Answer 53

Biopsy

Question 54

What is the outcome of chemo in a cat with high grade lymphoma?

Answer 54

50-70%, survival time of 6-10 months

Question 55

What is the outcome of chemo in a dog with high grade lymphoma?

Answer 55

Not good

Question 56

How do you treat a low grade lymphoma?

Answer 56

Low dose, long term chemo (prednisolone)

Question 57

What is the outcome of cats treated for low grade lymphoma?

Answer 57

68% complete remission | Mean survival 23 months

Question 58

What is delayed gastric outflow?

Answer 58

Food in stomach for >8hrs post-ingestion

Question 59

What is a clinical sign of delayed gastric outflow?

Answer 59

Projectile vomiting

Question 60

What are 3 causes of delayed gastric outflow?

Answer 60

Intramural dz Extramural compression FB

Question 61

What is the most common cause of outflow obstruction?

Answer 61

Pyloric stenosis

Question 62

What are the 2 types of pyloric stenosis?

Answer 62

Congenital pyloric stenosis Adult antral pyloric hypertrophy NOTE: Both are progressive

Question 63

Who most often has congenital pyloric stenosis?

Answer 63

Boxers | Boston Terriers

Question 64

What is involved in the congenital pylori stenosis?

Answer 64

Usually only muscle

Question 65

Who commonly gets adult antral pyloric hypertrophy?

Answer 65

Small breed dogs

Question 66

What is involved in adult antral pyloric hypertrophy?

Answer 66

Muscle and mucosa